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@#Objective To explore the differential expression of Sirtuin1 (SIRT1) in type A aortic dissection at diverse ages. Methods The expression of SIRT1 and monocyte chemoattractant protein-1 (MCP-1) in aortic tissue of the patients with type A aortic dissection (an aortic dissection group) and coronary heart disease (a control group) from 2019 to 2020 in the First Hospital of China Medical University was analyzed. In each group, the patients were divided into 3 subgroups according to the age (a younger subgroup, <45 years; a middle age subgroup, 45-60 years; an elderly subgroup, > Compared with the control group, SIRT1 protein expression decreased significantly in the aortic dissection group (the younger group: 0.64±0.18 vs. 1.18±0.47; the middle age group: 0.43±0.26 vs. 0.69±0.32; the elderly group: 0.31±0.24 vs. 0.45±0.29, P<0.01). The Western blotting results showed that the expression of SIRT1 protein in the aortic dissection group decreased with age (P<0.01). The MCP-1 protein expression of younger and middle age patients in the aortic dissection group was increased compared with that in the control group (the younger group: 0.65±0.27 vs. 0.38±0.22; the middle age group: 1.08±0.30 vs. 0.46±0.36, P<0.001). MCP-1 expression increased with age (P<0.01). The result of immunohistochemical staining for SIRT1 protein was similar to that of Western blotting. Conclusion The expression of SIRT1 decreases in patients with aortic dissection disease, and declines with age. SIRT1 may play an important role in the treatment and screening of type A aortic dissection.60 years). The quantitative real-time PCR, Western blotting and immunochemical stainning were used to detect the mRNA or protein expression of SIRT1 and MCP-1. Results A total of 60 patients were included in each group, including 79 males and 41 females. There were 20 patients in the yonger, middle age and elderly subgroups for the two groups, respectively. Compared with the control group, the expression of SIRT1 mRNA decreased in the aortic dissection group (the younger subgroup: 4.54±1.52 vs. 8.78±2.57; the middle age group: 2.70±1.50 vs. 5.74±1.07; the elderly group: 1.41±1.33 vs. 3.09±1.14, P<0.001). Meanwhile, SIRT1 mRNA in the aortic dissection group declined with age (P<0.01).
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Objective:To analyze and evaluate the safety and efficacy of a Chinese domestically manufactured Heart Con-type implantable third-generation magnetic and hydrodynamic levitation left ventricular assist device(LVAD) for the treatment of end-stage heart failure(ESHF), by reporting the results of eleven-center clinical trial on 50 cases.Methods:This study was a multicenter clinical trial, designed by means of prospective, multicenter and single-group target value. 50 subjects with ESHF were competitively enrolled and treated with HeartCon as the LVAD in eleven centers. The primary efficacy measure was survival, defined as either the subjects experiencing the transition to heart transplantation(HT) or myocardial recovery assisted by the device within 90 days, or as successfully assisted by the LVAD for full 90 days after implantation. The target survival rate was 60%, other observations included implantation success rate, mortality, pump failure needing replacement or emergency heart transplantation.Results:All enrolled 50 patients received LVAD implantation successfully, 46 survived with the pump for 90 days, 1 patient transitioned to heart transplantation, and 3 patients experienced pump thrombosis, within which 2 patients underwent pump replacement and continued to live with the pump for 90 days, and the other one received emergency heart transplantation. There were no dropout subjects. The survival rate at full 90 days after HeartCon implantation was 100%. The survival rates with pump in the full set analysis and the protocol set analysis were 96.00% and 95.92% respectively, which were higher than the target value of 60%. The differences were both statistically significant( P<0.05). Conclusion:The results of the multicenter clinical trial with the largest sample size in China using domestically manufactured third-generation LVAD has demonstrated that, HeartCon is a safe and effective LVAD to treat ESHF patients.
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Objective:To investigate the preoperative ascending aorta diameter in patients with acute type A aortic dissection in the Chinese population, compares and analyze the differences in preoperative blood biomarkers, and evaluate the impact of the preoperative ascending aorta diameter in this part of patients on the short-term prognosis of patients.Methods:A collection of 641 patients with acute type A aortic dissection who were enrolled in the " Acute Aortic Syndrome High-Risk Early Warning and Intervention Study" project from January 2018 to January 2020 were collected. Divide the patients into two groups (group Ⅰ<55 mm, group Ⅱ≥55 mm) according to the preventive intervention value of ascending aorta diameter recommended by the guideline for studying preoperative ascending aorta diameter difference in blood biomarkers and the influence of ascending aorta diameter on the short-term prognosis of patients. All patients had CT scans to assess the diameter of the ascending aorta before operation.Results:In this study, all patients with acute type A aortic dissection had a mean preoperative ascending aorta diameter of (46.9±9.7)mm. The preoperative ascending aorta diameter of all patients was less than 55 mm, accounted for 84.1%. Male patients were more likely to have aortic dissection than females; most patients' age was less than 60 years old. The preoperative blood inflammatory index counts were higher in the ascending aorta diameter ≥55 mm group. However, the long-term prognosis of patients with different ascending aorta diameters before surgery was not apparent in this study. The preoperative survival rate and short-term survival rate of patients with ascending aorta diameter <55 mm were higher than those of other groups, but the difference was not statistically significant.Conclusion:In patients with acute type A aortic dissection, the diameter of the ascending aorta is usually less than 55 mm. Moreover, the blood inflammatory index counts are high in the preoperative ascending aorta diameter ≥55 mm group. Meanwhile, patients with smaller ascending aorta diameter have better survival rate and short-term prognosis.
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Objective@#To observe the perioperative changes of serum thrombomodulin in patients with and without cardiogenic shock undergoing off-pump coronary artery bypass grafting surgery.@*Methods@#A total of 66 patients with coronary artery disease who underwent off-pump coronary artery bypass grafting surgery between June and December 2015 in our hospital were included in this study.The patients were divided into non-cardiogenic shock group (n=51) and shock group (n=15) according to the absence or presence of cardiogenic shock.The clinical data of the two groups were analyzed.Arterial blood samples were collected immediately after anesthesia, and at 4, 8, 16, 24, 48 and 72 hours after surgery.The levels of serum thrombomodulin were tested with enzyme-linked immunosorbent assay.@*Results@#(1)The prevalence of diabetes was significantly higher (64.7%(33/51) vs. 20.0%(3/15), P<0.01), while prevalence of myocardial infarction was significantly lower (41.2%(21/51)vs. 100%(15/15), P<0.01) in non-cardiogenic shock group than in cardiogenic shock group.(2)The peak plasma creatinine level, troponin I level and creatine kinase MB level were significantly lower in the non-cardiogenic shock group than in the cardiogenic shock group ((88.5±36.7) μmol/L vs. (122.6±71.1) μmol/L, 1.3(0.2, 2.7) μg/L vs. 16.4(5.8, 23.4) μg/L and (18.8±4.7) μg/L vs.(49.3±15.9) μg/L, respectively, all P<0.05). (3)Mechanical ventilation time was significantly longer (11.5 (9.0, 18.0) hours vs. 20.0 (8.5, 82.5) hours, P=0.02), and frequency of intra-aortic balloon pump use (0 vs. 100%, P<0.01) was significantly higher in the cardiogenic shock group than in the non-cardiogenic shock group.(4) Prevalence of atrial fibrillation (5.9%(3/51) vs. 80.0%(12/15)) and myocardial infarction (19.6%(10/51)vs. 93.3%(14/15)) that occurred during and after surgery was significantly lower in the non-cardiogenic shock group than in the shock group(all P<0.01). (5)The serum thrombomodulin concentration was similar among various time point in the non-cardiogenic shock group: 3.30(2.68, 7.44), 4.09(2.95, 7.18), 4.35(2.68, 8.22), 3.50(2.95, 8.00), 3.41(2.60, 5.97), 3.30(2.65, 5.42)and 3.94(2.82, 5.60) μg/L, taken immediately after anesthesia, and at 4, 8, 16, 24, 48 and 72 hours after surgery respectively, and was 2.44(1.97, 2.67), 2.21(1.93, 2.83), 2.64(2.29, 2.67), 2.84(2.26, 2.94), 3.35(2.43, 4.05), 2.76(2.73, 2.97) and 3.81(2.96, 5.96)μg/L respectively, in the cardiac shock group (all P>0.05). The serum thrombomodulin levels at 4 and 8 hours after surgery were higher in the non-cardiogenic shock group than cardiogenic shock group(all P<0.05).@*Conclusion@#Compared with the non-cardiogenic shock group, the peak serum thrombomodulin level appears later and recovers slower in cardiogenic shock patients who underwent off-pump coronary artery bypass grafting surgery.
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BACKGROUND:Studies have found that c-kit+ bone marrow mesenchymal stem cels can differentiate into myocardial cels specificaly, which may be the ideal seed cels. OBJECTIVE:To investigate the feasibility of cultivation of myocardial tissue by using c-kit+ bone marrow mesenchymal stem cels and decelularized heart matrix. METHODS:Heart tissues harvested from adult rats were decelularized for the folowing experiments. Primary rat bone marrow-derived mesenchymal stem cels were culturedin vitro. Until passage 8, bone marrow mesenchymal stem cels were enriched for c-kit and induced by 5 μmol/L 5-azacytidine for 2 weeks, and a second enrichment for the dihydropyridine receptor subunit α2δ1 was performed before analysis of cardiac differentiation or implantation into decelularized heart matrix for cultivation of myocardial tissue. Six weeks later, myocardial differentiation was identified by specific cardiac protein and action potential. Immunofluorescence staining was used to analysis neonatal myocardial tissue. RESULTS AND CONCLUSION:Six weeks after the second enrichment, 60% bone marrow mesenchymal stem cels expressed cardiac troponin T, GATA binding protein 4, and connexin 43, and these cels could be induced to yield cardiac action potential, which was identified as cardiac differentiation. And when implanted into decelularized heart matrix, these cels could form myocardial tissue arranged regularly.
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Objective To evaluate the effectiveness of mild hypothermia and the intra-aortic balloon pump (IABP) in postcardiac surgical patients with severe heart failure. Methods Twelve patients took combination therapy of IABP and mild hypothermia after cardiac surgery, which did not improve the low cardiac output with massive doses of catecholamine, were included in this study. The values of cardiac index (CI), mixed venous oxygen saturation (SvO2), urine volume and creati-nine (Cr) were measured before and after treatment. Results After combination therapy of IABP and mild hypothermia, the value of CI was improved obviously [L/(min·m2):2.4±0.5 vs 1.6±0.2], the value of SvO2 increased (0.65±0.07 vs 0.52±0.05 ), urine output increased obviously [mL/(kg·h):2.9±1.9 vs 1.2±0.9 ] and the value of Cr decreased obviously (mmol/L:95±10 vs 282±25 ). Conclusion The combination therapy of mild hypothermia and IABP is an effective and simple procedure for the postcardiac surgical patients with severe heart failure.
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Objective To investigate the effect of early coronary artery bypass grafting (CABG)to the left ventricular wall motion state and the significance of CABG to awake hibernating myocardial in dogs with acute myocardial infarction.Methods The anterior descending coronary of all thirty dogs were ligated into MI model.According to the operation date,the experimental groups included the 1 st week (n =6),the 2nd week (n =4),the 4th week (n =6) and the 6th week (n =6) CABG,and established control group (n =2) for every experimental group.Operators marked hibernate myocardial and determined the room wall motion score by means of dobutamine ultrasound load test (DSE) combining with tissue doppler imaging (DTI)technology before CABG and after eight weeks CABG through thoracotomy surgery for the experimental group and the control group.Every dog was executed and detected the area of MI.Results Four dogs of experimental group and all dogs of control group survived to the end of the study.The change of ventricular room wall motion score in the 1st and the 2nd week CABG was smaller than that in the 4th and the 6th week CABG and MI group(0.03 ±0.06,0.05 ±0.09,0.23 ±0.08,0.27 ±40.06,0.32 ±0.05,P ＜0.05).The change of room wall motion score in all CABG groups was smaller than that in MI group(1.195 ±0.09,1.25 ±0.18,1.30 ±0.18,1.36 ±0.11,1.65 ±0.17,P＜0.05).The hibernate myocardial were more awaken in all CABG groups than that in MI group (0.27 ± 0.12,0.22 ± 0.04,0.31 ± 0.09,0.23 ± 0.03,0.03 ± 0.04,P ＜ 0.05).The area of MI became smaller in 1 and 2 weeks CABG than that in 4 and 6 weeks CABG and MI group(20.75 ± 2.63,21.25 ± 2.5,27.25 ± 1.71,27.75 ± 2.22,P ＜ 0.05).Conclusions Early CABG surgery for dogs acute MI could improve the ventricular room wall motion obviously and wake up more hibernate myocardial.Especially,CABG surgery among two weeks could lessen the effect of MI to the ventricular room wall motion and reduce the scope of myocardial infarction maximatily.
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Objective To explore the surgical methods for the treatment of the total anomalous pulmonary venous connection (TAPVC) and choices to prevent related complications.Methods We analyzed retrospectively the clinical data of 24 cases with TAPVC admitted to our hospital from Jan 2006 to Dec 2011,including 15 male and 9 females with the age range of 50 d-14 years.There were 10 cases younger than six months,accounting for 41.7％ (10/24).The average body weight was (9.30 ± 3.96) kg.There were 8 cases 33.3％ (8/24) had a body weight of below 10.00 kg.Among the patients,16 cases (66.7％,16/24) were supracardic type,6 (25.0％) were cardiac type,and 2 (8.30％) were intracardiac type.For the treatment of the upracardiac type,5 cases were treated through the right atrium and interatrial septum incision path;Eleven cases were through the left atrial anastomosis.For the treatment of the cardiac type,the right atrial incision was used for coronary vein antrum isolation,and the patch was carefully packaged to separate the coronary sinus openings into the left atrial side.For the 2 cases of the intracardiac type,heart was slightly lift towards the right,and the venous anastomosis was performed for the left atrial posterior wall and the summary vein,and the vertical vein was then ligated.Results No surgery-related death occurred.Reoperation was performed for 1 patient occurred pulmonary edema due to pulmonary venous obstruction induced two days post-surgery.Condition was improved after the extension of left atrial side as the patient was found to have anastomotic stenosis.Postoperative arrhythmia were observed in 7 cases (29.2％,7/24),including 3 nodal arrhythmia (12.5％,3/24) and 4 (16.7％,4/24) atrial arrhythmia.Patients were followed up for 4-24 months.All children during the follow-up period were in good condition.They had significantly improved activity tolerance compared with pre-surgery.Chest X-ray showed clear markings free of congestion.Conclusion Appropriate surgical approach and routes could help improve the success rate of surgery treatment of TAPVC and reduce postoperative complications,thus achieving good therapeutic effect.
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Chronic total occlusion of the left main coronary artery [LMCA] is a rare condition, and the information on surgical experiences is limited. Although total occlusion of the LMCA is accompanied by well-developed collateral circulation, the condition of circulation is unstable during manipulation of the heart. We report our experience with revascularization in cases with total occlusion of the LMCA using the on-pump beating-heart [OnP-BH] technique. Retrospective case review of patients treated at The First Affiliated Hospital of China Medical University over a 10-year period [1999 to 2009]. The on-pump coronary artery bypass grafting with the beating heart was applied to 8 patients with chronic total occlusion of the LMCA. The extracorporeal circulation period, intubation duration, intensive care unit stay period, discharge period, preoperative and postoperative treatments, and follow-up were observed. The mean extracorporeal circulation period was 80.4 [19.7] minutes. The mean intubation duration was 13.0 [4.6] hours. The mean intensive care unit stay period was 3.2 [0.7] days, and the mean discharge period was 16.8 [3.3] days. No perioperative myocardial infarction occurred. The mean follow-up period was 50.9 [34.8] months. All patients were asymptomatic, and no deaths were recorded during the follow-up period. The results of echocardiography showed improvement in the left ventricular function. The OnP-BH myocardial revascularization seems to be a valid alternative for chronic total occlusion of the LMCA
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Isquemia Miocárdica/cirurgia , Resultado do Tratamento , Circulação Extracorpórea , Tempo de Internação , Contração Miocárdica , Estudos RetrospectivosRESUMO
<p><b>OBJECTIVE</b>To summarize the method and experience of cardiopulmonary bypass (CPB) with vacuum-assisted venous drainage technology (VAVD) in the minimally invasive cardiac surgery (MICS).</p><p><b>METHODS</b>35 cases of patients undergoing MICS were achieved femoral arterial cannula and femoral venous cannula. During the course of the CPB, we used the VAVD technology. At the same time, we selected 35 cases as control group.The time of the CPB, mechanical ventilation and ICU, and the amount of the urine, blood products, and chest drainage were recorded.</p><p><b>RESULTS</b>The time of mechanical ventilation and ICU staying, the volume of the blood products and the volume drainage within 48 h postoperatively in the MICS group were significantly shorter and less than that in control group (P < 0.05).</p><p><b>CONCLUSION</b>The use of VAVD in the MICS can increase the vena cava drainage effectively, and ensure the surgery safe and successful.</p>
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Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Procedimentos Cirúrgicos Cardíacos , Métodos , Drenagem , Métodos , Procedimentos Cirúrgicos Minimamente Invasivos , Métodos , Vácuo , VeiasRESUMO
Objective To investigate the effect and significance of early coronary artery bypass grafting (CABG) on the expression level of nerve-related factor at infracted border zone (IBZ) in dogs with acute myocardial infarction (AMI).Methods The anterior descending coronary artery of all thirty dogs randomly assigned into experimental group(n =22) and control group(n =8)were ligated into MI model.The experimental group included those undergoing CABG 1(n =6),2 week(n =4),4 week(n =6)and 6 week (n =6) after MI,and control group(n =2) was established for every experimental group.We detected the local expression level of nerve-related factor such as GAP43 mRNA,NGF mRNA and SYN mRNA at normal myocardium and infracted border zone myocavdium by means of RT-PCR through thoracotomy at eight weeks after surgery.Results Four dogs of every experimental group and all dogs of control group survived to the end of the study.The local expression level of GAP43 mRNA,NGF mRNA and SYN mRNA in control groups was significantly higher than that in normal and experimental groups (P ＜0.01 ).The local expression level of GAP43 mRNA,NGF mRNA and SYN mRNA in 4 and 6 weeks bypass groups was significantly higher than that in normal and 1,2 weeks bypass groups (P ＜0.05).There was no statistically significant the expression level of SYN mRNA among all experimental groups (P ＞ 0.05 ).Conclusions Early CABG surgery for AMI in dogs could lessen the expression level of nerve-related factor and the sympathetic remodelling at IBZ.Especially CABG surgery two weeks after MI could lessen the sympathetic maximacily.
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Objective To investigate the impact of diabetes on coronary artery bypass grafting (CABG)in peroperative patients. Methods Clinical data of 692 CABG patients were collected retrospectively from Sep. 2006 to Jul. 2010. The CABG patients were divided into diabetic group (n = 276) and nondiabetic group (n = 416) according to with the status of diabetes or not before operation. Blood glucose was dynamicaly monitored and treated with insulin to control blood glucose in perioperativeperiod. The postoperative effect,perioperative complication and inhospital case fatality and their relationship with diabetes were analyzed using univariate analysis. Results No significant differences were found regarding the incision complications (5. 8%vs. 4. 3 % , P > 0. 05). The volume of blood transfusion was (890. 7 ± 520. 6) ml in the diabetes group, which was not significantly different from that of (825. 2 ±518. 4)mlin the non-diabetes group (P>0. 05). No significant difference was found on cardiac arrhythmia (13.0% vs. 13. 5%),renal function insufficient (5. 1% vs. 2.4%)and case fatality (2. 9% and 1. 9%) between the diabetes and non-diabetes group (Ps >0. 05). In the diabetes group and non-diabetes group, the duration of IABP (3.7 ± 1. 6) d vs (3.5 ± 1.6)d, use of ventilator (2. 6 ± 1.9)d vs. (2. 4±1.5)d were not sigfnificantly different (Ps >0.05). The length of hospital stay and cost were (22. 0 ±8. 8)d and (8. 11 ±2. 40) thousand RMB in the diabetes group, which were significantly higher than that of (20. 6 ±7. 6)d and (7. 63 ±2. 20) thousand RMB in the non-diabeties group (t =2. 22 and 2. 71 ,Ps <0.05) . Conclusion There are no significant differences in the operative case fatality and complications between patients with diabetes and without nondiabetes. However,diabetes increases hospital stay and expense.
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Objective To investigate the diagnosis and therapy of primary maligmant tumors of the heart. Methods Clinical data of 21 patients with malignant cardiac tumors admitted to our department from June 1980 to May 2008 was analyzed and the references were reviewed. Results All patients received operations. Pathological classification of the tumors was made by histological examinations. Radical resections for 10 eases and partial resections for 5 eases were performed. The other 6 patients received only thoracotomy and cardiac exploration. Three eases were lost during follow up. Three survivors received radical resections are still alive now 2-15 months after the surgery, while all the other patients died within 4 years after the operation due to malignant tumor recurrence and (or) metastasis. Conclusion Echocardiography, CT, 3D-CT, MRI, coronary CT and angiocardiography are helpful for the diagnosis of the malignant cardiac tumors and the selection of operations. Histological examination is necessary for the final diagnosis. Early diagnosis, radical resection and post-operative radiotherapy and chemo therapy may provide a better result.
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Objective To develop a new rabbit model of myocardial infarction and assess left ventricular function and the survival rates.Methods A total of 30 adult rabbits were equally and randomly assigned into improved（n =15）and traditional model groups（n =15）.The rabbits were not intubated and ventilated in improved model group.A thoracotomy was performed along the left sternum by small nick with rib and pleura cavity integrity.The left anterodecendant arteries（LAD）of adult rabbits were ligated to establish animal models of my-ocardial infarction by a 60-min occlusion of the LAD,followed by reperfusion.In another group,rabbits were intubated and ventilated with rib abscised during thoracotomy inversely.Echocardiographic assessment was performed 3 weeks after myocardial infarction and survival rates were analyzed.Results Echocardiography showed that there was a sizable reduction in systolic and diastolic function in both groups with cardiac function significantly decreased 3 weeks later.Compared with traditional model group,improved method significantly increased the survival rate of rabbit model with myocardial ischemia.Conclusion This improved method is applicable to make an animal model of my-ocardial ischemia in rabbit.We established a simple,rapid,and effective method to mimick myocardial infarction in rabbit.
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@#Objective To observe the effects of rehabilitation on the quality of life and capacity of aerobic exercise in patients after coronary artery bypass graft. Methods 58 patients after coronary artery bypass graft were divided into rehabilitation group (n=31) and control group (n=27). Patients in the control group received routine drug treatment out of hospital, while the rehabilitation group was guided regularly for rehabilitation. All patients were surveyed with the MOS item short form health survey (SF-36) and 6 min walking test on the 15th and the 90th day after operation. Results Compared with the control group，the scores of all the items of SF-36 in rehabilitation group improved (P<0.01) except in body pain. The result of 6MWT was also higher in rehabilitation group than in controls(P<0.01). Conclusion Rehabilitation can improve capacity of aerobic exercise and the quality of life of patients after coronary artery bypass grafting.
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Objective To observe the effects of rehabilitation intervention on the quality of life (QOL) of patients after coronary artery bypass grafting. Methods Fifty-eight hospital patients in need of coronary artery by-pass grafting (CABG) were randomly assigned to a cardiac rehabilitation group ( rehab ; n = 31 ) or a routine care group (control; n = 27 ). In the rehab group, patients received progressively increasing movement and appropriate psychological intervention. Changes in the medical outcome study short form (SF-36) scores and 6 min walk dis-tances (6MWDs)as well as the length of post-operative stays in hospital were observed in both groups. Results Compared with the control group, patients in the rehab group scored significantly higher on the SF-36. Their physical functioning, general health, vitality, role-emotion and mental health scores improved significantly, their final 6MWDs were longer, and they had significantly shorter average hospital stays after the operation. Conclusions Rehabilita-tion training can improve QOL for patients after coronary artery bypass grafting.
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BACKGROUND:Bone marrow mesenchymal stem cells(BMSCs) have the potential to differentiate into various cells and growth factor plays a key role in cell engraftment, survival, and differentiation.OBJECTIVE:To observe the effects of hepatocyte growth factor(HGF) and insulin-like growth factor(IGF) combined with stem cell transplantation on cardiac function in rabbits after myocardial infarction.DESIGN, TIME AND SETTING:The randomized controlled animal study was performed at the Animal Experimental Center, China Medical University from November 2006 to March 2008.MATERIALS:A total of 28 healthy adult rabbits, of both genders, weighing 2.0-2.5 kg were used in this study.METHODS:Rabbit BMSCs were cultured in vitro.The left anterodecendant arteries(LAD) of adult rabbits were ligated to establish animal models of myocardial infarction by a 60-min occlusion of the LAD, followed by reperfusion.A total of 28 adult rabbits were equally and randomly assigned into 4 groups.In the combination group, rabbit models were injected with 8 ?L DMEM, supplemented with 5?1011/L BMSCs 40 ?L, 150 ?g/L HGF and 200 ?g/L IGF-1 at 3 days following model induction.In the stem cell group, rabbit models were infused with 5?1011/L BMSCs 40 ?L.In the growth factor group, rabbit models were injected with 8 ?L DMEM containing 150 ?g/L HGF and 200 ?g/L IGF-1.In the control group, rabbit models were treated with the same volume of DMEM.Three dimensional(3D) full volume image of the left ventricle was measured by IE33 model ultraphonic apparatus with 3D detecting head.MAIN OUTCOME MEASURES:The following parameters were measured:results of BMSC fluorescent labeling, end diastolic dimension, end systolic volume and ejection fraction of the left ventricle in each group at 6 weeks following model induction.RESULTS:A total of 28 adult rabbits were included in the final analysis.BMSCs adhered, with various morphology.Following 1 week, adhered cells gradually formed cell colony, with the presence of spindle-shape.At 2 weeks, about 80%-90% cells were confluent.Under a fluorescence microscope, DAPI-positive cells were found in the combination and stem cell groups.Positive cells were scattered in the rabbit myocardium, and surrounding the scar, along cardiac muscle fiber direction.Compared with the control and growth factor groups, cardiac function was significantly improved in the combination and stem cell groups(P
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BACKGROUND; As the bridge vessel, radial artery is easy to occur spasm and injury of endometrium, and the abnormal proliferation of endometrium, re-vasospasm, etc. appear at early period postoperatively, which can affect the operative outcomes.OBJECTIVE: To compare the effects of nitroglycenn (NTG), verapamil (VP), paraverine (PA), and the mixture of NTG and VP on relaxing spasm of radial artery in human being.DESIGN: A randomized controlled trial.SETTING: Department of Cardiosurgery, General Hospital of Shenyang Military Area Command of Chinese PLA.PARTICIPANTS: Thirty patients who underwent coronary artery bypass graft (CABG) with autologous radial artery, were selected from the Department of Cardiosurgery, General Hospital of Shenyang Military Area Command of Chinese PLA from September to November in 2006, including 18 males and 12 females, 48-74 years of age. Informed consents were obtained from all the patients or their relatives preoperatively.METHODS:① The samples of human radial artery in CABG were collected, and totally 95 vascular rings were used in this study. The rings were divided into five groups: NTG group, VP group, PA group, VP+NTG group and control group.There two parts of the experiment, vasospasm relaxation test and vasospasm prevention test. The vascular rings in the control group were only immersed in the Krebs- Ringer solution without any drug. ② Drugs: NTG was purchased from Solo Pak Laboratories (Franklin Park, IL), PA from Eli Lilly & Co., (Indianapolis, IN), VP and others from Sigma (St.Louis, MO). ③ Thirty vascular rings were used in the vasospasm relaxation test, and the method of bath chamber was applied. Deoxyepinephrine (terminal concentration of 1 ×10-3 mol/L) was added to stimulate the contraction and spasm of the vascular rings, then four vasodilatators were added, the concentrations of VP and NTG were 30 μmol/L, and that of PA was 0.1%. Relaxation rate=(resting tension after stimulation-initial resting tension)/initial resting tension× 100%. ④ The other 60 vascular rings were used in the vasospasm prevention test. Firstly, the rings were immersed in the four solutions of vasodilatators of corresponding concentrations and Krebs- Ringer solution respectively for 30 minutes. After pretreatment, the vascular rings were randomly divided intc normothermia group (n =30) and cryopreservation group (n =30). In the cryopreservation group, the vascular rings were put into the Krebs-Ringer buffer solution at 4 ℃, and kept in refrigerator at 4 ℃ for 24 hours. The spasms of radial artery were observed.MAIN OUTCOME MEASURES: Changes of resting tension (degree of contraction and relaxation rate of dilatation) of vascular rings before and after administration.RESULTS: ① Effect on the dilatation of spastic radial artery: The radial artery was completely within 11 minutes in all the VP+NTG group, VP group, NTG group and PA group. But in the first 3 minutes, the dilating effects of VP+NTG and NTG were obviously better than the other two groups. The dilatation curves showed that the dilating ability in order was VP+NTG ＞ NTG ＞ VP ＞ PA. ② Effect of pretreatment of radial artery on antispasm: In the normothermia group, the contractility of the vascular ring produced by 1 ×10-3 mol/L deoxyepinephrine was close between the VP+NTG group and VP group [(0.47±0.06), (0.49±0.08) g, P ＞ 0.05], which were obviously different from those in the NTG group and PA group [(0.81±0.22), (0.87±0.26) g, P ＜ 0.05]. After cryopreservation for 24 hours, the contractility in the VP+NTG group was not obviously different from that in the VP group [(0.86±0.11), (0.90±0.13) g, P ＞ 0.05], and obviously lower than those in the NTG group, PA group and control group [(4.82±0.87), (5.00±0.53), (5.10±0.67) g, P ＜ 0.01], whereas those in the NTG group and PA group were close to that in the control group (P ＞ 0.05).CONCLUSION: The drugs can prevent and relax the spasm of radial artery to different extents, whereas considering from preventing spasm and the time-effect of treatment, the mixture of VP and NTG seems to be more proper as the preparation solution for the treatment of radial artery in CABG.
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<p><b>OBJECTIVE</b>To investigate the cardioprotective effects of morphine on ischemic reperfused rat heart in vitro and its mechanism.</p><p><b>METHODS</b>The isolated rat heart was perfused in a Langendorff apparatus. Infarct myocardium was determined by TTC. Coronary flow (CF), heart rate (HR), left ventricular pressure (LVP), the first derivative of ventricular pressure (LVP/dtmax) and infarct size after ischemia and reperfusion in rat heart given 0.3 micro mol/L morphine were observed. The effects of naloxone and glibenclamide on the cardioprotection of morphine were also measured.</p><p><b>RESULTS</b>After ischemia and reperfusion, CF, HR, LVP and LVP/dtmax of isolated rat hearts decreased significantly (P < 0.01). After morphine preconditioning, HR, LVP and LVP/dtmax increased (P < 0.01) and infarct size was reduced significantly (P < 0.01), while no significant change in CF (P > 0.05). The cardioprotective effects of morphine were abolished by naloxone or glibenclamide completely.</p><p><b>CONCLUSIONS</b>Morphine can reduce ischemia-reperfusion injuries in isolated rat heart. The cardioprotective effects of morphine are mediated by a local opioid receptor-K(ATP) channel linked mechanism in rat hearts.</p>
Assuntos
Animais , Masculino , Ratos , Cardiotônicos , Farmacologia , Glibureto , Farmacologia , Coração , Técnicas In Vitro , Precondicionamento Isquêmico Miocárdico , Morfina , Farmacologia , Traumatismo por Reperfusão Miocárdica , Naloxona , Farmacologia , Ratos WistarRESUMO
Objective To study the feasibility and clinical experience of off-pump multivessel coronary artery bypass grafting (OPCAB) for patients with acute myocardial infarction (AMI). Methods Sixty-one patients with AMI were treated surgically. The mean age of was (64.7?7.2) years. The last attack angina pectoris unreliable with use of Nitro-Glycerine, and the levels of CK-MB documented (3.5?1.8) times and TnI were (10.9?4.1) times higher than the normal. OPCAB was performed in sixty-one patients and in two patients, converted to cardiopulmonary bypass. All patients were followed up from twelve months to twenty-four months. Results The mean interval between the onset of AMI and the accomplishment of OPCAB was (115.8?15.1) hours ,and the number of distal anastomosis was (3.4?0.7)/pt. The mortality rate was 3.28%. During the period of follow-up, all patients were asymptomatic and the results of echocardiography showed the function of ventricles improved. Conclusion Off-pump technique applying to multivessel coronary artery disease with AMI yielded satisfied clinical outcome. The morbidity and mortality of OPCAB is substantially lower maybe due to avoiding the adverse effects of CPB.